Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma Resection

Kinney, Michelle A.O.; Warner, Mary E.; vanHeerden, Jon A.; Horlocker, Terese T.; Young, William F.; Schroeder, Darrell R.; Maxson, Pamela M.; Warner, Mark A.

doi:10.1213/00000539-200011000-00013

Cited by 39 publications

(53 citation statements)

References 17 publications

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“…A study by Parnaby et al showed that laparoscopic adrenalectomy for pheochromocytoma was indeed associated with increased episodes of severe intraoperative hypertension (SBP >200-220 mmHg) when compared to the laparoscopic resection of other adrenal tumors (47). Interestingly, a creation of peritoneum has been shown to increase catecholamines release which may result in hemodynamic instability (35,48,49). Moreover, case control studies confirmed that in terms of hemodynamic instability laparoscopic approach is equal to open procedure (50,51).…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Section: Intraoperative Considerationsmentioning

confidence: 99%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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“…Its use should be avoided in patients with cardiomegaly and cardiomyopathy. 8 Labetalol with α: β, 1:5 antagonistic activity is used for control of tachycardia, but not as an initial therapy before α-blockade. 1 Anaesthesia management has been a formidable challenge including risks of catecholamine secretion similar to that in PCC, delayed gastric emptying and massive blood loss.…”

Section: Discussionmentioning

confidence: 99%

Precarious encounter with Paraganglioma during cystoscopic excisional biopsy of urinary bladder tumour

Gadre

2017

Sri Lankan J Anaesthesiol

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Tumours secreting catecholamine are a known perioperative anaesthetic challenge. However, extra adrenal location of such tumors can cause sudden catastrophe in unprepared patients. A 45 year old, 50 kg female patient scheduled for transurethral cystoscopic resection of bladder tumour of suspected neoplastic aetiology, developed sudden, severe tachycardia, hypertension, and arrhythmias followed by hypotension under general anaesthesia. Tumour biopsy obtained during first surgery confirmed diagnosis of Paraganglioma (PGL). This was supported with normal vanillyl mandelic acid (VMA), 6.5mg/24hrs (normal 2-8mg/24hrs) and a large polypoidal mass on CT in a patient with episodic symptoms of headache and blackout associated with micturition; a classical triad reported about this tumour category. Findings of MIBG (Meta iodo benzyl guanidine) 131 I scan that reported no MIBG avid disease, were equivocal. Accurate diagnosis, good perioperative control of blood pressure and volume status using invasive monitoring and cascade of drugs to manipulate circulation when required, formed the essence of successful management of the patient during her second surgery.

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“…While hemodynamic instability associated with surgical and laparoscopic resection of known or suspected pheochromocytoma has been reported (9,10), the risk of resection in the population of unsuspected pheochromocytoma has not been well described to our knowledge. Two out of four of our patients demonstrated intraoperative hemodynamic instability that may have been prevented by appropriate preoperative alpha-blockade.…”

Section: Commentsmentioning

confidence: 98%

Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma

et al. 2011

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Purpose: To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. Materials and Methods: Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation. Results: None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct. Conclusion: Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.

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Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma Resection

Cited by 39 publications

References 17 publications

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Precarious encounter with Paraganglioma during cystoscopic excisional biopsy of urinary bladder tumour

Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma

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